Cirurgia cardiovascular no estado da Bahia: avaliação do acesso pela análise de redes

Abstract

The objective of this study is to evaluate the access to cardiovascular surgery from indexes of the networks in the state of Bahia. For that, we selected hospitalizations for cardiovascular surgery at SIH-SUS, from 2008 to 2018, in the municipalities of Bahia-Brazil. The follow network indices were applied: entry degree, exit degree, exit flow and mean size of the exit edge. For analyses among macro-regions were used the following indicators: (i) hospitalization rate forcardiovascular surgery performed by macro-regions, (ii) proportion of municipalities with zero exit per macro-regions and (iii) size output edge average per macro-regions. The methodology used showed an increase in the rate of cardiovascular surgery from 1.3 in 2008 to 1.97 per 10,000 inhabitants in 2018. There was a lack of concentration of access to hospitalizations for this type of surgery; decrease in the number of municipalities with no record of cardiovascular surgery (24.9%) and also decrease in the distance traveled by users in search of these procedures (18.7%). There have been advances in access to cardiovascular surgery in the state, with significant changes in the pattern of intercities displacement during the historical serie. Initially, the best results, such as the drop in the proportion of municipalities with an exit degree equal to zero and a drop in the average size of the exit edge, were linked to the macro-regions that have within its geographic territory, a reference municipality for carrying out these procedures. As of 2016, there was another change in the patterns of displacement, where the drop in the proportion of municipalities with a degree of exit equal to zero fell, even, for macro-regions that do not have this service within their macro-region.